Pandemic Flu Alert Level Raised to Phase 5; World Health Organization Director-General says: "Certain Actions Should now be Undertaken with Increased Urgency, and at an Accelerated Pace"

Oregon’s first probable case of swine flu was identified late Wednesday following testing by the Oregon State Public Health Laboratory.

“The probable case was in a Multnomah County adult female who consulted her physician after experiencing flu-like symptoms,” according to Dr. Mel Kohn, head of the Oregon Public Health Department. The woman, who was not hospitalized and is recovering normally, had contact with someone who had recently traveled to Mexico and been exposed to the swine flu there, he said.

The specimen from this case was sent to U.S. Centers for Disease Control and Prevention (CDC) for further characterization, with final results of testing expected in several days.

“It is very likely that this test will be confirmed by the final step of laboratory testing,” Kohn said. “So we are not waiting -- we are treating this as a case of swine flu.”

This case is identified as probable, rather than confirmed, because the final step of testing has not yet been performed. However, she did test positive with non-typeable Influenza A. Results from the tests done so far by the CDC indicate that more than 95 percent of cases with this test result will ultimately test positive for the swine flu once the final step of testing is finished.

Portland metro area health departments are investigating the situation to identify who may have been exposed to this case, and to slow further transmission.

“Our first priorities are to provide information to people to help them protect themselves and to slow the spread of this new strain of flu virus,” said Dr. Gary Oxman, health officer for Multnomah, Clackamas and Washington counties.

State and local health departments continue to operate at high alert. The state public health lab continues to receive new cultures from health care providers. So far the other cases have tested negative for flu, but Dr. Kohn said it is likely that there will be additional cases in the future.

“We have expected to see a case in Oregon and the public health system is responding well,” Dr. Kohn said. “Oregon’s state and local public health officials are working together and with federal officials to slow spread of the disease and to continue to protect the public.

“I know Oregonians are concerned and want to know what they can do to protect themselves and their families,” said Dr. Kohn. “This doesn’t change our advice -- wash your hands, cover your cough and if you are sick stay home.”

He said these are actions people can take to prevent the spread of the flu:

* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners also are effective.

* Cover your coughs and sneezes with a tissue or your sleeve, not with your hand;

* Stay home if you are sick;

* Try to avoid contact with people who are ill; and

* Practice other good health habits such as eating a balanced diet, exercising regularly, getting sufficient rest and not smoking.

Although not mentioned in the OHDS news release regarding the first probable Oregon swine flu case, information regarding pandemic flu may be found on the U.S. government's web site, pandemicflu.gov. According to the site's report "Interim Public Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic", facemasks and respirators should be used in combination with other preventive measures, such as hand hygiene and social distancing, to help reduce the risk for influenza infection during a pandemic.

Pandemicflu.gov also says, however, that the swine flu outbreak is not yet classified as a pandemic, which they describe as a virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. "Currently, there is no pandemic flu," the web site stated, but the influenza pandemic alert status was raised to phase 5 on Wednesday.

The World Health Organization (WHO) so far in the progression of the virus, says they are coordinating the global response to human cases of swine influenza A (H1N1) and monitoring the corresponding threat of an influenza pandemic.

WHO Director-General, Dr Margaret Chan, after raising the influenza pandemic alert from phase 4 to phase 5 on April 29, said "This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions should now be undertaken with increased urgency, and at an accelerated pace." Chan further mused, "The biggest question, right now, is this: how severe will the pandemic be, especially now at the start?"

A quick internet search reveals advertisements for and sales of N95 respirator masks are increasing rapidly. Many web sites such as EmergencyMasks.com report heightened sales activity of the NIOSH-certified masks, but advise consumers that surgical masks being sold elsewhere are not likely to provide the same level of protection as the N95 and higher-rated masks. "Surgical facemasks do not form a tight seal on the wearer’s face and are not designed to filter out small particles that can be inhaled and that may have a role in influenza transmission. NIOSH-certified N95 and higher filtering facepieces are made of dense material that is certified to filter out very small particles that can be inhaled, and will also block both small splashes and large droplets," their web site stated, quoting information provided on PandemicFlu.gov.

Key facts from PandemicFlu.gov:

·If used correctly, facemasks and respirators may help to prevent some exposures while in a crowded setting.

·When individuals are ill with respiratory symptoms (e.g., coughing, sneezing) during an influenza pandemic, they should stay at home except when it is critically necessary to leave (e.g., to obtain medical care). Individuals with a respiratory illness should wear a facemask to contain respiratory secretions (e.g., to cover coughs and sneezes) if they are in the presence of others.

·Since a facemask worn by a coughing person may reduce the amount of potentially infectious material released into the surrounding area, one strategy for reducing the spread of influenza would be to encourage everyone to wear a facemask while they are together if a group gathering is unavoidable. This might reduce the overall risk to the group by increasing the likelihood that all unanticipated coughs and sneezes would be covered and that respiratory secretions would not be widely spread while people are speaking or breathing.

·If a gathering is unavoidable, individuals may consider wearing a facemask or respirator to help prevent exposure to respiratory secretions from symptomatic individuals.

·NIOSH-certified N95 and higher filtering facepieces are made of dense material that is certified to filter out very small particles that can be inhaled. To be most effective, these types of respirators should form a tight seal against the wearer’s face. They also will block both small splashes and large droplets.

·Both facemasks and respirators may be beneficial in discouraging wearers from inadvertently touching their nose or mouth with unwashed hands, which could help prevent virus transmission and infection.

·If there is the expectation of close contact with a symptomatic individual, every effort should be made to limit the duration of exposure to the ill individual(s) to as short a period as possible. In such situations, proper use of a well-fitted N95 or higher respirator may be a reasonable choice.

·Planning assumptions project that there will likely be shortages of respirators during a sustained pandemic. For example, quantities of N95 or higher respirators may have to be prioritized for use by certain healthcare workers whose occupational activities place them at increased risk for infection.